MEDICARE: DR. MICHELLE RENEE LEVALLEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	17302	CA

General Provider Information

NPI Number	:	1942305826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE RENEE LEVALLEY PH.D.

Provider Business Mailing Address
First Line	:	4441 E KINGS CANYON RD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93702-3604
Country	:	US
Telephone Number	:	559-600-9180
Fax Number	:	559-455-4641

Provider Business Practice Location Address
First Line	:	2085 E DAKOTA AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-4804
Country	:	US
Telephone Number	:	559-600-1500
Fax Number	:	559-455-4641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	09/30/2013

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